title: Liver fibrosis progression at autopsy in injecting drug users infected by hepatitis C: a longitudinal long-term cohort study.
abstract: OBJECTIVE
  There is a paucity of unbiased data on the natural history of hepatitis C virus (HCV) infection in injecting drug users (IDUs). The purpose of this study was to assess the risk of developing advanced fibrosis associated with chronic hepatitis C (CHC) infection among injecting drug users (IDUs) who underwent an autopsy.
  
  
  METHODS
  A longitudinal cohort design was applied, in which the stage of liver fibrosis in anti-HCV positive IDUs with or without chronic HCV infection was assessed in liver tissue from autopsies performed up to 35 years after HCV exposure. The cohort originated from 864 IDUs consecutively admitted for drug abuse treatment 1970-1984. Stored sera, mostly drawn at the time of admission for drug treatment, were available in 635 subjects. 220 out of 523 anti-HCV positive subjects had died before 2009. Liver tissue from autopsies was available from 102/220 subjects, of which 61 were HCV RNA positive. Liver sections were classified according to METAVIR scores for fibrosis. Two pathologists, both blinded for serologic results, scored sections of liver tissue.
  
  
  RESULTS
  Among HCV RNA positive subjects 16.4% (10/61) had septal fibrosis (F3) or cirrhosis (F4) compared to 2.4% (1/41) among anti HCV positive/HCV RNA negative subjects (p=0.026). Of 18 HCV RNA positive subjects autopsied <15 years after HCV exposure none had F3 or F4. Among subjects autopsied >25 years after exposure 35% (6/17) had F3-F4.
  
  
  CONCLUSIONS
  Among IDUs chronically infected by HCV, 1/3 developed septal fibrosis or cirrhosis 25 years or more after exposure.
authors.affiliation: National Centre for Dual Diagnosis, Innlandet Hospital Trust, 2381 Brumunddal, Norway; Norwegian Centre for Addiction Research, University of Oslo, Norway. Electronic address: knkiella@online.no.
authors.forename: Knut Boe
authors.initials: KB
authors.lastname: Kielland
authors.affiliation: Department of Forensic Pathology and Clinical Forensic Medicine, Norwegian Institute of Public Health, PO Box 4404 Nydalen, N-0403 Oslo, Norway; Faculty of Medicine, University of Oslo, Norway.
authors.forename: Gerd Jorunn Møller
authors.initials: GJ
authors.lastname: Delaveris
authors.affiliation: Department of Forensic Pathology and Clinical Forensic Medicine, Norwegian Institute of Public Health, PO Box 4404 Nydalen, N-0403 Oslo, Norway; Faculty of Medicine, University of Oslo, Norway.
authors.forename: Sidsel
authors.initials: S
authors.lastname: Rogde
authors.affiliation: Department of Pathology, Oslo University Hospital, PO Box 4950 Nydalen, N-0424 Oslo, Norway; Faculty of Medicine, University of Oslo, Norway.
authors.forename: Tor Jacob
authors.initials: TJ
authors.lastname: Eide
authors.affiliation: Norwegian Institute for Alcohol and Drug Research, PO Box 565 Sentrum, N-0105 Oslo, Norway.
authors.forename: Ellen J
authors.initials: EJ
authors.lastname: Amundsen
authors.affiliation: Department of Infectious Diseases, Akershus University Hospital, N-1478 Lørenskog, Norway; Faculty of Medicine, University of Oslo, Norway.
authors.forename: Olav
authors.initials: O
authors.lastname: Dalgard
mesh_terms: D000328:Adult; D001344:Autopsy; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000473:pathology / Q000821:virology; D006801:Humans; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000209:etiology* / Q000473:pathology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009664:Norway; D012367:RNA, Viral / Q000097:blood; D015819:Substance Abuse, Intravenous / Q000150:complications*
chemical_list: D012367:RNA, Viral
keywords: ALT; CHC; CI; Cirrhosis; Drug abuse; HBsAg; HCC; HCV; Hepatitis C; IDU; IQR; Liver fibrosis; Longitudinal; METAVIR; PWID; RNA; Steatosis; alanine transaminase; anti-HBc; anti-HCV; chronic hepatitis C; confidence interval; hepatitis B core antibody; hepatitis B surface antigen; hepatitis C antibody; hepatitis C virus; hepatocellular carcinoma; injecting drug user; interquartile range; ribonucleic acid